Prevalence of depression and diabetes: a population-based study from rural Bangladesh

To determine the extent of depressive symptoms in a rural community of Bangladesh and its association with newly recognized diabetes.

Depressive symptoms were assessed in 184 newly diagnosed diabetic subjects and 768 randomly selected individuals without diabetes. The Montogomery and Aasberg Depression Rating Scale (MADRS) was used to assess depressive symptoms. A structured interview was performed to obtain socio-demographic and economic information and anthropometric measures were collected. Fasting plasma glucose was measured by the HemoCue glucose analyser.

Twenty-nine percent of male and 30.5% of female participants with diabetes and 6.0% of male and 14.6% of female subjects without diabetes had depressive symptoms rating > or = 20 on the MADRS. An association between depressive symptoms and diabetes was found (P < 0.01). After controlling for potential confounding factors including age, gender, fasting plasma glucose > 7.0 mmol/l and waist-hip ratio, the association of depression with diabetes remained significant.

An unexpectedly high level of unrecognized depressive symptoms was found in the general rural population of Bangladesh. These are among the first data to suggest that depressive symptoms in this culture are common, especially in women. Depression is particularly common in those with diabetes. Psychiatric intervention may be necessary in addition to lifestyle changes to prevent the exponential increase in the occurrence of Type 2 diabetes. In addition, a common approach including psychiatric treatment in diabetes care may be necessary to achieve improved glycaemic control in this population.